Vol. 6, Issue 1, Part A (2024)

Autoimmune myositis represents a group of rare inflammatory disorders characterized by muscle inflammation, weakness, and chronic pain, often influenced by complex physiological and psychological factors. This case report presents a 19-year-old female with a history of von Willebrand disease, depression, and attention deficit hyperactivity disorder, diagnosed with autoimmune myositis who experienced chronic bilateral lower extremity pain with neuropathic features, including allodynia, weakness, and paresthesias. The patient’s symptoms were refractory to conventional treatments, including non-steroidal anti-inflammatory drugs, lumbar sympathetic nerve blocks, and various pharmacological agents, leading to significant functional decline.
Pain in autoimmune myositis is attributed to nociceptor sensitization driven by inflammation, pro-inflammatory cytokine cascades, and central sensitization, which amplifies pain perception. Comorbidities such as von Willebrand disease and mental health conditions further complicates pain management. These factors precluded the patient from undergoing a thoracolumbar spinal cord stimulator trial, which requires active patient engagement and regular follow-ups. Depression and attention deficit hyperactivity disorder exacerbate pain perception and complicate adherence to treatment regimens, necessitating targeted management strategies.
This case underscores the need for a comprehensive and multidisciplinary approach to managing pain in autoimmune myositis, integrating optimized treatment of comorbid conditions and multimodal therapies. Despite its limited impact on life expectancy, autoimmune myositis significantly impairs quality of life, making effective symptom control paramount. The findings emphasize the importance of understanding the mechanisms underlying pain sensitization and the psychosocial dynamics influencing chronic pain to achieve better outcomes.